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20 Cards in this Set

  • Front
  • Back
H - Home
E - Education and employment
E - Eating disorder screening
A - Activities (A does not stand for "acne.")
D - Drugs
S - Sexuality
S - Suicide risk and depression
S - Safety (fights, car, weapons)

start this process at an early age (9-10 years)
first set of adolescent immunizations @ 12–

reccommended @ 16
Tdap, MCV4, and all 3 doses of HPV at age 12

MCV4 booster since shes now 16 and had her initial MCV4 vaccine when she was 12 years old. In addition, you recommend the annual flu vaccine.
hypothyroid sx
Cold skin, slowness, preferring hot weather to cold, and doing poorly at school are all typical signs of hypothyroidism in an adolescent.

Rash on the legs and feet edema are symptoms of hypothyroidism more often found in adults.

Adolescents also often present with fatigue and poor school performance
Mono in ddx for fatigue
very tired with mono, they also have a bad sore throat that lasts for a while and sometimes swollen glands. Mono is actually an infection of lymphocytes, a white blood cell type, caused by the Epstein-Barr virus
periods in adolescence
adolescents menses are often light and irregular (especially in the first two years), causing more cramping and discomfort. They normally do not produce clots. If girls are using extra tampons and pads, it is usually because they are changing frequently, rather than soaking them through
ddx fatigue in 16y/o
depression, adjustment reactions to stressors, or other mental health issues
Of the depression symptoms below, which ONE is more common in adults than in adolescents?
Wakes early in the morning; has difficulty falling asleep at night

Many healthy adolescents experience mood swings. These behaviors are usually not indicative of depression. Other teens may have some difficulty in adjusting to new circumstances, such as moving while in high school or a breakup with a significant other. These adjustment reactions tend to be short and do not usually cause lasting effects
Tools for depression screening
Children's Depression Inventory (CDI) for ages 7 to 17;

adolescents, the Beck Depression Inventory (BDI) and the Center for Epidemiologic Studies Depression (CES-D) Scale

Recently, even shorter, two-question screeners have been validated for teens. The two questions were "Have you ever felt that life is not worth living?" and "Have you ever felt like you wanted to kill yourself?"
anorexia or bulimia
severe emaciation, over-exercising and laxative-taking may be evident. Bulimia may be difficult to diagnose because of the lack of weight loss in the early stages. You may find a family history of similar conditions or other psychiatric illness, especially suicidal attempts and depression.

If the adolescent becomes defensive during questioning or does not seem to be opening up, it is best to change tactics and ask questions that don't have an emotional overlay. You might potentially return to the discussion later, after you have established rapport.
anorexic? If her Body Mass Index gradually reduces until she was < 75% of the ideal body weight for height (measured through BMI), which of the following would be the expected progression of clinical, laboratory and ECG findings as her illness became more and more severe?
Bradycardia, electrolyte imbalances, arrhythmias, circulatory collapse, death

weight loss or failure to gain and in females, amenorrhea
next physical finding usually noted is bradycardia. While mostly asymptomatic, the bradycardia may lead to decreased cardiac output severe enough to lead to postural hypotension= hospitalized for intensive treatment to prevent further progression and for nutritional stabilization.
electrolyte abnormalities begin to manifest. While the patient may have several issues related to the malnutrition, including hypoalbuminemia, hypoglycemia, or hyponatremia (due to excessive water intake), these do not tend to be severe enough to lead to significant immediate complications
continued deficiencies of calcium and magnesium may lead to neurologic changes, increased reflex tone, and compromised cardiac function.

25% of cases happen in boys. Bulimia can be more difficult to diagnose because of lack of weight loss in early stages. Sometimes, only secondary effects are manifest, such as dental decay (from stomach acid) or finger trauma from self-induced vomiting
ddx anemia
She has had no significant respiratory illnesses (the worst being influenza.) There have been no gastrointestinal illnesses and she does not have vomiting or diarrhea. She has had no joint pain or swelling (thinking about rheumatologic conditions). Betsy does not have any frequent urination, thirst, or unusual hunger (eliminating diabetes). She had her tonsils removed in childhood after frequent 3 episodes of pharyngitis in a 6-month period.
runs in families
causes menstral abnormalities (menorhaggia, shorter menstral cycles)
wt gain
dec in appetite
bleeding disorder
1/5 w menorrhagia have bleeding disorders
more likely to cause fatigue than chronic anemia b/c rapid loss of hemoglobin
platelets and clotting factors
family hx of anemia

frequent nose bleeds, sometimes with clots, and easy bruising
anemia caused by Fe deficiency alone doesnt hava as much fatigue b/c
body compensates ex increasing blood volume but eventually will have sx but might take a while
Minor confidentiality
Although some states give doctors the option of informing parents that their minor son or daughter has engaged in risk behaviors, these laws leave the decision of whether to inform the parents to the discretion of the physician in determining the best interest of the minor.

While confidentiality is very important, ability to consent for these issues, even without the parent, is supported by the federal judicial law concept of the mature minor. Remember that the ethical principle of autonomy should allow the adolescent to make decisions, if he/she is able to give informed consent.

same-sex-loving teens are at markedly higher risk for mental health issues and suicidality, and unprotected sex.
Often, it is easier for teens to talk about other teens, so one useful (if not evidence-based) strategy is to ask about risk behaviors in peers first and then bridge to the individual
go from the least intrusive and easiest to talk about to the most difficult, which is usually sexuality and mental health
sexual maturity or Tanner stages
Girls start puberty at 8-13 years:
Breast buds appear (at 10-11 years) then,
Pubic hair appears (at 10-11 years) then,
Growth spurt (at 12 years) then,
Periods begin (menarche at 12-13 years) then,
Adult height (at 15 years)

Boys start puberty at 10-15 years:
Growth of testicles (at 12 years) then,
Pubic hair appears (at 12 years) then,
Growth of penis, scrotum (at 13-14 years) then,
First ejaculations (at 13-14 years) then,
Growth spurt (at 14 years) then,
Adult height (at 17 years)

constitutional short stature, denoting that he was a “late-bloomer” in puberty but that he would achieve a normal adult height, just later than his peers.
bleeding disorder tests
Complete blood count (CBC) with platelets, red blood cell indices, and a smear
Reticulocyte count
Prothrombin time (PT) and partial thromboplastin time (PTT); platelet function test (which has largely replaced the bleeding time in most centers)
Factor VIII activity
von Willebrand factor antigen
von Willebrand factor activity (also known as Ristocetin cofactor)
von Willebrand's disease (vWD)
most common hereditary bleeding disorder (1% of the population)
autosomal dominant inheritance with variable penetrance (Type 1 and all Type 2 subcategories)
much less common Type 3 is inherited as an autosomal recessive.
history is often the most sensitive indicator of the disease.

Type I vWD is the most common type (70%) and the mildest. The bleeding generally is not life-threatening. 

laboratory diagnosis of vWD can be challenging
prolonged platelet function or bleeding time and mild prolongation of the aPTT point to the diagnosis of vWD. However, the aPTT may be normal and the patient will still have vWD.
Therefore, to confirm vWD, check the von Willebrand's factor antigen and/or platelet function analysis and factor VIII levels.
vWD sx
Ecchymoses (small hematomas in areas of trauma)

Epistaxis, menorrhagia (so vWD is diagnosed more often in women than men)
Bleeding post-tonsillectomy, post-dental extractions, and gingival bleeds

In the absence of major trauma, bruising in non-exposed areas (buttocks, back, trunk) needs to be thought of as abnormal. Remember that child abuse can also be the cause of such bruising.
tx vWD/ most bleeding problems
Treatment for most of the bleeding problems most often consists of intranasal or intravenous desmopressin.

Sometimes human plasma-derived, virally inactivated Von Willibrand’s factor concentrate may be administered.

For menorrhagia, combination contraceptive pills, or levonorgestrel intrauterine device